The purpose of this research is to evaluate a structural pilot intervention which aims to expand pharmacy services to include provision of non-occupational HIV post exposure prophylaxis (nPEP) and risk reduction information to injection drug users (IDUs) who buy syringes at two pharmacies registered with the New York State Expanded Syringe Access Program (ESAP), a program allowing pharmacies to sell syringes without a prescription to help reduce the spread of HIV among IDUs. PEP is the standard of care for health care workers who experience an accidental needle stick. The probability of HIV transmission in IDUs through sharing syringes is either similar to or higher than the risk of an occupational needle stick, which supports the use of nPEP in these cases. There is a preponderance of data supporting PEP (i.e., antiretroviral therapy) as an effective strategy to prevent HIV infection. Thus, PEP is recommended by the U.S. Department of Health and Human Services in non-occupational cases (exposure via high risk sex or injection behavior) when the exposure source is HIV positive or when the source is unknown but from a HIV prevalent community (e15%). ESAP's success creates a new window of opportunity to offer nPEP as a medically-based HIV prevention approach to low-risk IDUs such as ESAP participants who mostly access sterile syringes but may have an unplanned exposure. By targeting pharmacies in low-income, black and Hispanic communities where HIV burden is highest, a pharmacy-based nPEP program has the potential to create a more comprehensive HIV prevention plan that addresses the long-standing problem of racial disparities in HIV/AIDS. Thus, we aim to qualitatively and quantitatively evaluate a pharmacy-based nPEP program by comparing IDU syringe customers who would agree to pharmacy-based nPEP vs. those who would decline (in the event of an accidental exposure) with respect to demographics, risk behaviors, perceptions of health care access/needs among IDU syringe customers. Using a pre/post design targeted to syringe customers and their peers we will determine if IDUs/peers who receive nPEP information and risk reduction counseling are more likely to 1) have increased and accurate knowledge of nPEP as an HIV prevention strategy (over time), and 2) more frequently share accurate information about nPEP, risk reduction, and HIV prevention with peers (over time) with respect to baseline demographics, risk behavior, and healthcare needs and access (Aim 2). Among those request nPEP and eligible (i.e., low injection/sex risk IDUs) we will assess side effects and nPEP adherence, risk behavior, social networks, and attitudes and opinions about nPEP via clinical follow up. We will conduct key- informant interviews among key stakeholders (n=15) and enroll IDU syringe customers (and referred peers) from pharmacies providing nPEP information/risk reduction counseling via print materials and video followed by a baseline A-CASI survey (n=638). A peer-driven intervention component will facilitate recruitment and dissemination of nPEP information. Participants will return in 3-months to assess behavior, knowledge, and spread of nPEP information. Analysis will include standard qualitative and quantitative regression techniques. PUBLIC HEALTH RELEVANCE: The proposed research is highly significant and innovative in that it aims to explore new venues for HIV prevention for injection drug users (IDUs), namely pharmacies participating in a nonprescription syringe sales program aimed at increasing sterile syringe access among IDUs in New York City (NYC). This new HIV prevention strategy adds a medical model to the current HIV prevention strategy. This new strategy includes delivery of post exposure prophylaxis (PEP) in non-occupational situations such as following injection or sexual exposure to HIV which has been recommended by CDC and evaluated among men who have sex with men but never before among IDUs. Our goal is to specifically tackle HIV racial disparities by targeting our pilot intervention to the black and Hispanic communities most heavily burdened with HIV/AIDS. Building on years of IDU and pharmacy-based research, we have selected two public health-minded pharmacies with a sizable and consistent IDU syringe purchasing customer base as the initial PEP delivery venue (as opposed to a visit to a medical setting to obtain a prescription) since IDUs typically experience challenges in accessing care. If successful, this model can be duplicated not only throughout other high-risk neighborhoods in New York, but in several other cities and states where similar pharmacy syringe access programs exist. Broader public health impact could also follow, for example, pharmacists can partner with clinicians and other health care providers, including community based organizations to offer these expanded services to groups with limited access to health care services.